Let’s Talk About Irritable Bowel Syndrome (IBS)
If you have suffered with IBS you will know it can be incredibly frustrating. Having suffered for over 20 years, I understand your frustration. The most difficult thing clinically for patients with IBS is that there is no one size fits all approach that will support symptoms and it can take a long time to gain an understanding of what works for each individual.
So what is IBS and how do I support patients clinically?
Many patients I see suffer with relentless discomfort such as abdominal bloating, gas, pain and discomfort, constipation, diarrhoea or a combination of both. As you can imagine these symptoms can also bring with them anxiety and challenges to quality of life. IBS does not have any abnormality to the structure of the gut (this is where it differs from other inflammatory disorders). When you look under a microscope, all parts of the gut look normal which means there is no issue with the functioning of the gut or the way it works.
Since there is no known cause, treatment is generally limited to symptomatic relief from symptoms and strategies to support quality of life. Unfortunately, what works for one patient will not work for the other so many lifestyle and dietary factors need to be taken into consideration.
The below are some key factors that I address in clinical practice with my patients
1. Changes in the gut microbiome
2. Altered gut-brain interaction
3. Gastrointestinal sensitivity
4. Altered intestinal motility
Your microbiome health matters
Beneficial bacteria play a role in supporting your overall health. A healthy gut has a large amount of beneficial bacteria which utilises dietary fibre to produce compounds that feed our gut cells. This is where eating the rainbow truly comes in handy. If you have an imbalance of beneficial and not so beneficial bacteria this may cause gut symptoms such as excessive bloating due to the over-fermentation of fibre. Essentially when your non beneficial bacteria thrive, symptoms may arise.
Your gut and brain talk to each other
Have you ever noticed when you are stressed, your gut symptoms get worse? This is because of the two-way connection between your central nervous system and your gut, known as the gut-brain axis. This connection causes the nervous bowel symptoms associated with stress and those butterflies in your stomach.
One way IBS is aggravated by stress is through boosting pain sensitivity. Your response to stress matters, research indicated that people with a heighted stress response are more likely to experience IBS. This is where supporting your stress resilience through mindfulness activities really support overall symptoms.
How Inflammation plays a role
Inflammation alerts the immune system to the presence of an infection or damage, to ensure healing can begin. When inflammation is severe in the gut or perpetual it can become chronic and damage the cells lining the gut. If this occurs it can be difficult for you to absorb nutrients and the balance of your good bacteria may be compromised.
However, in IBS, FODMAP-containing foods are over-fermented by ‘bad’ gut bacteria, resulting in excessive gas production and pain. Limiting high FODMAP foods can help identify your food triggers; however, should be implemented under the guidance of a qualified practitioner.
Changes to Intestinal Motility
Changes to intestinal motility from abnormal gut contractions may result in IBS symptoms such as abdominal pain and discomfort. Many studies have shown that IBS patients have various gastrointestinal disturbances that arise from an exaggerated physiological response to diet and lifestyle factors. Supporting the digestion and movement of foods through the gastrointestinal system can be super important to support IBS symptoms and to help with absorption of nutrients.
As part of a treatment plan for my patients, I always utilise dietary and lifestyle factors. This may include gaining an understanding of the types of foods you are reacting too. The FODMAP diet can be incredibly helpful here, however I have to stress this diet should be followed with a trained practitioner as it is not a long term. I also focus my attention on ways to enhance gut sensitivity and altered intestinal motility. This will include dietary and supplement approaches as well as lifestyle factors. And the most important component and one where I see the most profound shift is helping to support the gut brain axis. This involves ways to calm the nervous system, support stress resilience and improve sleep.
As you can see there is so much to consider when looking at IBS clinically. If you are confused about your symptoms and need additional support, get in touch. I would love to support you through your IBS journey.
Yours in health,
Roshelle xx
References
[1] Ng KS, Nassar N, Hamd K, Nagarajah A, Gladman MA. Prevalence of functional bowel disorders and faecal incontinence: an Australian primary care survey. Colorectal Dis. 2015 Feb;17(2):150-9. doi: 10.1111/codi.12808.
[2] Mykletun A, Jacka F, Williams L, Pasco J, Henry M, Nicholson GC, et al. Prevalence of mood and anxiety disorder in self reported irritable bowel syndrome (IBS). An epidemiological population based study of women. BMC Gastroenterol. 2010 Aug 5;10:88. doi: 10.1186/1471-230X-10-88.
[3] Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012.
[4] Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012.
[5] Seddik HA, Bendali F, Gancel F, Fliss I, Spano G, Drider D. Lactobacillus plantarum and its probiotic and food potentialities. Probiotics Antimicrob Proteins. 2017 Jun;9(2):111-122. doi: 10.1007/s12602-017-9264-z.
[6] Kujawa-Szewieczek A, Adamczak M, Kwiecień K, Dudzicz S, Gazda M, Więcek A. The effect of Lactobacillus plantarum 299v on the incidence of Clostridium difficile infection in high risk patients treated with antibiotics. Nutrients. 2015;7(12):10179-88. doi:10.3390/nu7125526.